Why is Environmental Public Health Tracking Important?Environmental health programs across the country lack the necessary financial resources/infrastructure to adequately respond to increasing public concerns over disease prevalence and the role of the environment. For many diseases about which the public has voiced concern (e.g., asthma), standardized disease registries do not exist to enable public health officials to respond in a timely way regarding the possible relationship (or lack thereof) between the disease and environmental exposures. By establishing EPHT programs across the country, public health officials will be able to better respond to these community concerns.

What is Massachusetts doing for its Environmental Public Health Tracking Projects?In 2002, Massachusetts was one of seven state or local health departments in the country to receive funding to implement environmental public health tracking systems. The health outcomes and environmental exposures during this initial funding cycle in Massachusetts were as follows:

Developmental Effects in Berkshire County and Areas of PCB contamination in the Housatonic River Area

Adverse birth outcomes (e.g., low birth weight) and exposures to total trihalomethanes in drinking water

Childhood cancers and exposures to volatile organic compounds in drinking water

Childhood lead poisoning and exposures to lead near historical smelter sites or lead in drinking water

What have been some key findings from the Massachusetts EPHT projects?The Massachusetts EPHT projects demonstrated the feasibility of implementing health and environmental tracking linkage projects. Some key findings include the following:

Using school health records, Massachusetts now has a statewide pediatric asthma tracking system in place, now entering its fourth year of data collection. This reporting has been shown to be highly reliable and complete.

The first three years of statewide pediatric asthma rates (for K-8) ranged from 9-10 percent (annual reports can be found at www.mass.gov/dph/ceh)

Linkage analyses of indoor air quality data revealed a statistically significant association between the occurrence of pediatric asthma in schools and the presence of moisture problems in the school

The development of an electronic statistical tool now enables MDPH staff to more quickly evaluate patterns of childhood cancer (as well as any other cancer) on a neighborhood or census tract level in relation to environmental exposure information for that area (the tool is called the standardized incidence ratio, or SIR, calculator). Future efforts will be aimed at addressing confidentiality issues so that information can be available to local health officials, researchers, etc.

Final demonstration reports on all projects are being submitted to CDC for review.

What important lessons were learned from the Massachusetts experience?The initial funding from EPHT was to demonstrate that EPHT could work on a state or national scale. It also was to help identify whether barriers or challenges may exist for certain outcomes or environmental data. The Massachusetts experience resulted in some important lessons relevant to the national initiative, including the following:

Massachusetts had hoped to use a rich source of readily available information from the Massachusetts Department of Education to evaluate whether unusual patterns of developmental disabilities might be occurring in Berkshire County in relationship to opportunities for exposures to PCBs. However, the federal Family Education Rights and Privacy Act (FERPA), which prohibits state education departments from sharing their data for EPHT purposes. Hence, given the significant FERPA barriers to developing a robust tracking system for developmental disabilities, this outcome was not deemed feasible for EPHT at this time.

Some diseases may be too resource-intensive to compile tracking systems in part due to complex and non-standardized diagnostic criteria.

What are the next steps in Massachusetts?Massachusetts successfully applied for funding from the U.S. Centers for Disease Control and Prevention for the next round of EPHT activities, starting in August 2006 and scheduled for five years. CDC aims to implement a national network of health and environmental tracking data that can be shared with interested parties and used to help implement public health policies and generate hypotheses for further public health evaluation. Among the outcomes being tracked during the current funding are the following:

Hospitalization data for asthma and cardiac outcomes

Various types of cancers, including short latency cancers (e.g., childhood cancer)

Blood lead data

Birth defects

Low birth weight

The primary environmental data that will be used to link with health outcome data include drinking water quality and ambient air data for various contaminants (e.g., particulate matter in ambient air; volatile organic compounds in drinking water).

Who can I contact for more information on Massachusetts Environmental Public Health Tracking Projects?Please contact the Center for Environmental Health, Massachusetts Department of Public Health, at 617-624-5757, or visit our website, www.mass.gov/dph/environmental_health.